Generic placeholder image

Current Hypertension Reviews

Editor-in-Chief

ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

Systematic Review Article

Impact of Metabolic Surgery on Type 2 Diabetes Mellitus, Cardiovascular Risk Factors, and Mortality: A Review

Author(s): Ricardo Cohen , Noelia S. Sforza* and Romina G. Clemente

Volume 17, Issue 2, 2021

Published on: 04 August, 2020

Page: [159 - 169] Pages: 11

DOI: 10.2174/1573402116666200804153228

Price: $65

Abstract

Background: The association between obesity and a reduction in life expectancy is well established, and cardiovascular disease is a leading cause of mortality. Bariatric surgery has long been established as the most effective and durable intervention for obesity, and is the only intervention for obesity that consistently improves multiple comorbidities, reduces cardiovascular disease and long-term mortality. The purpose of this review is to describe the impact of metabolic/bariatric surgery on type 2 diabetes mellitus and cardiometabolic parameters, including cardiovascular mortality.

Methods: A systematic literature search of Pubmed, MEDLINE, and Cochrane Central Register was performed. We included randomized controlled trials, meta-analysis, case-control trials, and cohort studies that contain data on reductions in cardiovascular risk factors and cardiovascular mortality in subjects who underwent metabolic/bariatric surgery from January 1, 2005 to June 1, 2020.

Conclusion: There is sufficient evidence from randomized controlled trials that metabolic/bariatric surgery is associated with a significant improvement of all cardiovascular risk factors. Although studies are showing a reduction of macrovascular events and cardiovascular mortality, these findings come from observational studies and should be confirmed in randomized clinical trials.

Keywords: Bariatric surgery, metabolic surgery, systematic review, obesity treatment, cardiovascular mortality, type 2 diabetes mellitus.

Graphical Abstract
[1]
Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature 2006; 444(7121): 875-80.
[http://dx.doi.org/10.1038/nature05487] [PMID: 17167476]
[2]
Riaz H, Khan MS, Siddiqi TJ, et al. Association Between Obesity and Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Mendelian Randomization Studies. JAMA Netw Open 2018; 1(7)e183788
[http://dx.doi.org/10.1001/jamanetworkopen.2018.3788] [PMID: 30646365]
[3]
Courcoulas AP, Christian NJ, Belle SH, et al. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310(22): 2416-25.
[http://dx.doi.org/10.1001/jama.2013.280928] [PMID: 24189773]
[4]
Bianchi C, Del Prato S. Metabolic memory and individual treatment aims in type 2 diabetes--outcome-lessons learned from large clinical trials. Rev Diabet Stud 2011; 8(3): 432-40.
[http://dx.doi.org/10.1900/RDS.2011.8.432] [PMID: 22262079]
[5]
el al Dixon JB. International Diabetes Federation Taskforce on Epidemiology and Prevention. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med 2011; 28: 628-42.
[http://dx.doi.org/10.1111/j.1464-5491.2011.03306.x]
[6]
Wing RR. Look AHEAD Research Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010; 170(17): 1566-75.
[PMID: 20876408]
[7]
Consensus Development Conference Panel. NIH conference. Gastrointestinal surgery for severe obesity. Ann Intern Med 1991; 115(12): 956-61.
[http://dx.doi.org/10.7326/0003-4819-115-12-956] [PMID: 1952493]
[8]
Rubino F, Kaplan LM, Schauer PR, Cummings DE. Diabetes Surgery Summit Delegates. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2010; 251(3): 399-405.
[http://dx.doi.org/10.1097/SLA.0b013e3181be34e7] [PMID: 19934752]
[9]
Rubino F, Nathan DM, Eckel RH, et al. Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016; 39(6): 861-77.
[http://dx.doi.org/10.2337/dc16-0236] [PMID: 27222544]
[10]
Cohen RV, Shikora S, Petry T, Caravatto PP, Le Roux CW. The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation. Obes Surg 2016; 26(8): 1989-91.
[http://dx.doi.org/10.1007/s11695-016-2237-6] [PMID: 27189354]
[11]
Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med 2014; 370(21): 2002-13.
[http://dx.doi.org/10.1056/NEJMoa1401329] [PMID: 24679060]
[12]
Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE Investigators. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med 2017; 376(7): 641-51.
[http://dx.doi.org/10.1056/NEJMoa1600869] [PMID: 28199805]
[13]
Dixon JB, le Roux CW, Rubino F, Zimmet P. Bariatric surgery for type 2 diabetes. Lancet 2012; 379(9833): 2300-11.
[http://dx.doi.org/10.1016/S0140-6736(12)60401-2] [PMID: 22683132]
[14]
Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 2012; 35(7): 1420-8.
[http://dx.doi.org/10.2337/dc11-2289] [PMID: 22723580]
[15]
Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg 2015; 150(10): 931-40.
[http://dx.doi.org/10.1001/jamasurg.2015.1534] [PMID: 26132586]
[16]
Pihlajamäki J, Grönlund S, Simonen M, et al. Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Metabolism 2010; 59(6): 866-72.
[http://dx.doi.org/10.1016/j.metabol.2009.10.004] [PMID: 20015521]
[17]
Ricci C, Gaeta M, Rausa E, Asti E, Bandera F, Bonavina L. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg 2015; 25(3): 397-405.
[http://dx.doi.org/10.1007/s11695-014-1442-4] [PMID: 25240392]
[18]
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386(9997): 964-73.
[http://dx.doi.org/10.1016/S0140-6736(15)00075-6] [PMID: 26369473]
[19]
Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013; 309(21): 2240-9.
[http://dx.doi.org/10.1001/jama.2013.5835] [PMID: 23736733]
[20]
Ikramuddin S, et al. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of HbA1c, LDL-c, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. JAMA 2018; 319(3): 266-78.
[http://dx.doi.org/10.1001/jama.2017.20813] [PMID: 29340678]
[21]
Salminen P, Helmiö M, Ovaska J, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA 2018; 319(3): 241-54.
[http://dx.doi.org/10.1001/jama.2017.20313] [PMID: 29340676]
[22]
Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial. JAMA 2018; 319(3): 255-65.
[http://dx.doi.org/10.1001/jama.2017.20897] [PMID: 29340679]
[23]
Hofsø D, Fatima F, Borgeraas H, et al. Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol 2019; 7(12): 912-24.
[http://dx.doi.org/10.1016/S2213-8587(19)30344-4] [PMID: 31678062]
[24]
Arterburn D, Wellman R, Emiliano A, et al. PCORnet Bariatric Study Collaborative. Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study. Ann Intern Med 2018; 169(11): 741-50.
[http://dx.doi.org/10.7326/M17-2786] [PMID: 30383139]
[25]
Schiavon CA, Bersch-Ferreira AC, Santucci EV, et al. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation 2018; 137(11): 1132-42.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.117.032130] [PMID: 29133606]
[26]
Miller GD, Nicklas BJ, Fernandez A. Serial changes in inflammatory biomarkers after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2011; 7(5): 618-24.
[http://dx.doi.org/10.1016/j.soard.2011.03.006] [PMID: 21546319]
[27]
Woelnerhanssen B, Peterli R, Steinert RE, Peters T, Borbély Y, Beglinger C. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy--a prospective randomized trial. Surg Obes Relat Dis 2011; 7(5): 561-8.
[http://dx.doi.org/10.1016/j.soard.2011.01.044] [PMID: 21429816]
[28]
Pritchett AM, Deswal A, Aguilar D, et al. Lifestyle modification with diet and exercise in obese patients with heart failure a pilot study. J Obes Weight Loss Ther 2012; 2(2): 1-8.
[http://dx.doi.org/10.4172/2165-7904.1000118] [PMID: 23125955]
[29]
Aggarwal R, Harling L, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes. Obes Surg 2016; 26(5): 1030-40.
[http://dx.doi.org/10.1007/s11695-015-1866-5] [PMID: 26328532]
[30]
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357(8): 753-61.
[http://dx.doi.org/10.1056/NEJMoa066603] [PMID: 17715409]
[31]
Sjostrom L, el al . Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307(21): 56-65..
[32]
Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart 2012; 98(24): 1763-77.
[http://dx.doi.org/10.1136/heartjnl-2012-301778] [PMID: 23077152]
[33]
Benotti PN, Wood GC, Carey DJ, et al. Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure. J Am Heart Assoc 2017; 6(5)e005126
[http://dx.doi.org/10.1161/JAHA.116.005126] [PMID: 28536154]
[34]
Vest AR, Heneghan HM, Schauer PR, Young JB. Surgical management of obesity and the relationship to cardiovascular disease. Circulation 2013; 127(8): 945-59.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.112.103275] [PMID: 23439447]
[35]
Johnson BL, Blackhurst DW, Latham BB, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg 2013; 216(4): 545-56.
[http://dx.doi.org/10.1016/j.jamcollsurg.2012.12.019] [PMID: 23391591]
[36]
Cohen R, Caravatto PP, Petry T, Cummings D. Role of metabolic surgery in less obese or non-obese subjects with type 2 diabetes: influence over cardiovascular events. Curr Atheroscler Rep 2013; 15(10): 355.
[http://dx.doi.org/10.1007/s11883-013-0355-3] [PMID: 23955664]
[37]
Kwok CS, Pradhan A, Khan MA, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol 2014; 173(1): 20-8.
[http://dx.doi.org/10.1016/j.ijcard.2014.02.026] [PMID: 24636546]
[38]
Beamish AJ, Olbers T, Kelly AS, Inge TH. Cardiovascular effects of bariatric surgery. Nat Rev Cardiol 2016; 13(12): 730-43.
[http://dx.doi.org/10.1038/nrcardio.2016.162] [PMID: 27762312]
[39]
Cardoso L, Rodrigues D, Gomes L, Carrilho F. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes Metab 2017; 19(9): 1223-32.
[http://dx.doi.org/10.1111/dom.12922] [PMID: 28244626]
[40]
Gero D, Favre L, Allemann P, Fournier P, Demartines N, Suter M. Laparoscopic Roux-En-Y Gastric Bypass Improves Lipid Profile and Decreases Cardiovascular Risk: a 5-Year Longitudinal Cohort Study of 1048 Patients. Obes Surg 2018; 28(3): 805-11.
[http://dx.doi.org/10.1007/s11695-017-2938-5] [PMID: 28971303]
[41]
Cohen RV, Pereira TV, Aboud CM, et al. MOMS Study Investigators. Microvascular Outcomes after Metabolic Surgery (MOMS) in patients with type 2 diabetes mellitus and class I obesity: rationale and design for a randomised controlled trial. BMJ Open 2017; 7(1)e013574
[http://dx.doi.org/10.1136/bmjopen-2016-013574] [PMID: 28077412]
[42]
Zhou K, Wolski K, Malin SK, et al. Impact of weight loss trajectory following randomization to bariatric surgery on long-term diabetes glycemic and cardiometabolic parameters. Endocr Pract 2019; 25(6): 572-9.
[http://dx.doi.org/10.4158/EP-2018-0522] [PMID: 30865529]
[43]
Fisher DP, Johnson E, Haneuse S, et al. Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity. JAMA 2018; 320(15): 1570-82.
[http://dx.doi.org/10.1001/jama.2018.14619] [PMID: 30326126]
[44]
Aminian A, Aleassa EM, Bhatt DL, et al. Bariatric surgery is associated with a lower rate of death after myocardial infarction and stroke: A nationwide study. Diabetes Obes Metab 2019; 21(9): 2058-67.
[http://dx.doi.org/10.1111/dom.13765] [PMID: 31050119]
[45]
Aminian A, Zajichek A, Arterburn DE, et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA 2019; 2019
[http://dx.doi.org/10.1001/jama.2019.14231] [PMID: 31475297]
[46]
Billeter AT, Eichel S, Scheurlen KM, Probst P, Kopf S, Müller-Stich BP. Meta-analysis of metabolic surgery versus medical treatment for macrovascular complications and mortality in patients with type 2 diabetes. Surg Obes Relat Dis 2019; 15(7): 1197-210.
[http://dx.doi.org/10.1016/j.soard.2019.04.029] [PMID: 31201113]
[47]
Oliveira SC, Neves JS, Souteiro P, et al. AMTCO Group. Impact of Bariatric Surgery on Long-term Cardiovascular Risk: Comparative Effectiveness of Different Surgical Procedures. Obes Surg 2020; 30(2): 673-80.
[http://dx.doi.org/10.1007/s11695-019-04237-0] [PMID: 31749108]
[48]
Kumar SB, Hamilton BC, Wood SG, Rogers SJ, Carter JT, Lin MY. Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis 2018; 14(3): 264-9.
[http://dx.doi.org/10.1016/j.soard.2017.12.011] [PMID: 29519658]
[49]
Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis 2017; 13(4): 568-74.
[http://dx.doi.org/10.1016/j.soard.2016.11.029] [PMID: 28089434]
[50]
Yeung KTD, Penney N, Ashrafian L, Darzi A, Ashrafian H. Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis. Ann Surg 2020; 271(2): 257-65.
[http://dx.doi.org/10.1097/SLA.0000000000003275] [PMID: 30921053]
[51]
Zinman B, Wanner C, Lachin JM, et al. EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117-28.
[http://dx.doi.org/10.1056/NEJMoa1504720] [PMID: 26378978]
[52]
Neal B, Perkovic V, Mahaffey KW, et al. CANVAS Program Collaborative Group. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377(7): 644-57.
[http://dx.doi.org/10.1056/NEJMoa1611925] [PMID: 28605608]
[53]
Wiviott SD, Raz I, Bonaca MP, et al. DECLARE–TIMI 58 Investigators. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019; 380(4): 347-57.
[http://dx.doi.org/10.1056/NEJMoa1812389] [PMID: 30415602]
[54]
Marso SP, Daniels GH, Brown-Frandsen K, et al. LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375(4): 311-22.
[http://dx.doi.org/10.1056/NEJMoa1603827] [PMID: 27295427]
[55]
Gerstein HC, Colhoun HM, Dagenais GR, et al. REWIND Investigators. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019; 394(10193): 121-30.
[http://dx.doi.org/10.1016/S0140-6736(19)31149-3] [PMID: 31189511]
[56]
Lars Sjöström MD. Ph.D. Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications. JAMA 2014; 311(22): 2297-304.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy